TAILIEUCHUNG - Chapter 020. Hypothermia and Frostbite (Part 5)

Hypothermia: Treatment When a patient is hypothermic, target organs and the cardiovascular system respond minimally to most medications. Moreover, cumulative doses can cause toxicity during rewarming because of increased binding of drugs to proteins, and impaired metabolism and excretion. As an example, the administration of repeated doses of digoxin or insulin would be ineffective while the patient is hypothermic, and the residual drugs are potentially toxic during rewarming. Achieving a mean arterial pressure of at least 60 mmHg should be an early objective. If the hypotension does not respond to crystalloid/colloid infusion and rewarming, low-dose dopamine (2–5 µg/kg per min) support. | Chapter 020. Hypothermia and Frostbite Part 5 Hypothermia Treatment When a patient is hypothermic target organs and the cardiovascular system respond minimally to most medications. Moreover cumulative doses can cause toxicity during rewarming because of increased binding of drugs to proteins and impaired metabolism and excretion. As an example the administration of repeated doses of digoxin or insulin would be ineffective while the patient is hypothermic and the residual drugs are potentially toxic during rewarming. Achieving a mean arterial pressure of at least 60 mmHg should be an early objective. If the hypotension does not respond to crystalloid colloid infusion and rewarming low-dose dopamine 2-5 pg kg per min support should be considered. Perfusion of the vasoconstricted cardiovascular system may also be improved with low-dose IV nitroglycerin. Atrial arrhythmias should initially be monitored without intervention as the ventricular response will be slow and unless preexistent most will convert spontaneously during rewarming. The role of prophylaxis and treatment of ventricular arrhythmias is problematic. Preexisting ventricular ectopy may be suppressed by hypothermia and reappear during rewarming. None of the class I agents has proved to be safe and efficacious. When available bretylium tosylate was the class III ventricular antiarrhythmic of choice. There is no evidence that amiodarone is safe. Initiating empirical therapy for adrenal insufficiency is usually not warranted unless there is a history suggesting steroid dependence hypoadrenalism or a failure to rewarm with standard therapy. The administration of parenteral levothyroxine to euthyroid patients with hypothermia however is potentially hazardous. Because laboratory results can be delayed and confounded by the presence of the sick euthyroid syndrome Chap. 335 historic clues or physical findings suggestive of hypothyroidism should be sought. When myxedema is the cause of hypothermia the relaxation .

• Y học thường thức
• Hypothermia and Frostbite
• bệnh học và điều trị
• bài giảng bệnh học
• tài liệu học ngành y
• Harrisons Internal Medicine
• medical books
• pharmacology
• epidemiologic
• Obstetrics
• anatomy
• Preventing Morbidity
• Multidisciplinary Care
• Harrisons principles of internal medicine
• Internal medicine
• Quality of health care
• Developed countries
• Health care systems
• Chest discomfort
• Clinical medicine
• The cardiovascular system
• Critical care medicine
• The kidney and urinary tract
• The gastrointestinal system
• The joints and adjacent tissues
• Neoplasms of the Lung
• tài liệu y khoa
• bệnhbệnh học và điều trị
• Sodium and Water học và điều trị
• General considerations in clinical medicine
• Cardinal manifestations
• Presentation of diseases
• The environment and disease
• Regenerative medicine
• Introduction to clinical medicine
• The environment
• Disorders of the cardiovascular system
• Disorders of the respiratory system
• Disorders of the gastrointestinal system
• Infectious diseases
• The respiratory system
• Neurologic Disorders
• Moraxella Infections
• Haemophilus Infections
• Bệnh truyền nhiễm
• Tim mạch
• Tiết niệu
• Tiêu hóa
• Cơ xương khớp
• Acute rheumatic fever
• Antiphospholipid syndrome
• Inflammatory myopathies
• Relapsing polychondritis
• Pituitary tumor syndromes